Immunotherapy and Stereotactic Ablative Radiotherapy for Lung Cancer with Co-existing Interstitial Lung Disease: A Case Report

Abstract

•Patients with interstitial lung disease are at increased risk for lung cancer, have worse outcomes compared with patients with non–interstitial lung disease lung cancer, and are at higher risk for treatment-related toxicity. •Here, we report a patient with interstitial lung disease who initially presented with early stage non–small cell lung cancer, who was not a surgical candidate and refused stereotactic ablative body radiotherapy owing to a heightened risk of complications. •He progressed on surveillance to have metastatic non–small cell lung cancer, which was found to have ultra-high programmed death ligand-1 expression (>99%). He was started on first-line pembrolizumab, which has been well-tolerated and resulted in an excellent response. •Our case highlights important considerations when treating lung cancer in patients with interstitial lung disease and reviews the pertinent literature regarding the use of stereotactic ablative body radiotherapy and immunotherapy in these patients. •Patients with interstitial lung disease are at increased risk for lung cancer, have worse outcomes compared with patients with non–interstitial lung disease lung cancer, and are at higher risk for treatment-related toxicity. •Here, we report a patient with interstitial lung disease who initially presented with early stage non–small cell lung cancer, who was not a surgical candidate and refused stereotactic ablative body radiotherapy owing to a heightened risk of complications. •He progressed on surveillance to have metastatic non–small cell lung cancer, which was found to have ultra-high programmed death ligand-1 expression (>99%). He was started on first-line pembrolizumab, which has been well-tolerated and resulted in an excellent response. •Our case highlights important considerations when treating lung cancer in patients with interstitial lung disease and reviews the pertinent literature regarding the use of stereotactic ablative body radiotherapy and immunotherapy in these patients.